Use the paper provided and add missing information as per instructions. Use Template providedBased on the standards of care for management of chronic wounds and the paper provided, complete this power point for presentation. Ordering Labs and Studies: Standard of care that is expected when the results return as a wound care provider (NP, PA or MD).LESS FOCUS ON HOW THE PROCEDURE IS DONE AND MORE ON WHAT IT IS FOR AND WHAT TO DO WHEN RECEIVING THE RESULTS. Youll cover the testing that is ordered, the executive thought process behind the testing request and what priority planning takes place that will lead you to medical decision making for outlining your treatment plan and what medical necessity charting is to be included.
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Ordering Labs and Studies: Wound Care Standard of care as NP, PA, or MD
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Ordering Labs and Studies: Wound Care Standard of care as NP, PA, or MD
Managing chronic wounds involves ordering laboratory tests and investigations, which is
an important factor in managing chronic wounds. It aids in identifying diseases accurately, plays
a massive role in determining the right course of treatment, and results in improved outcomes of
treatment delivered to the patient. There are numerous more tests for chronic wound care, and
their significance can only be finished with the correct idea of these different tests. According to
Krasner & van Rijswijk (2018), the most devastating impact of chronic wounds is their
prevalence of 6.5 million people in the United States, underlining the importance of appropriate
management and treatment. Ordering labs and studies is a gradual process, highlighting that one
needs some jurisdiction in this process. It entails the evaluation of a patient and the factors
antecedent to implementation of the intervention, acuity of clinical condition, and propensity for
post-surgical complications, as well as examination of clinical necessity for additional
examinations and tests. That is why it is crucial to understand the rationale for ordering these
tests at the executive level to get more clarification on the cause of chronic wounds and to chart a
direction toward a course of action. For instance, the wound culture helps in instating the
presence of an infection, whereas the biopsy helps in confirming the presence of diseases like
osteomyelitis.
Chronic wound care involves priority planning and physician decision-making that can
be useful for patients. It also leads to the identification of the correct tests to conduct and then the
outcome, as well as determining the outcome and analyzing it appropriately within the least
amount of time (Eriksson et al., 2020). Specifically, charting is vital in capturing every test and
treatment step in the medical necessity of the case from legal, clinical, legal, and insurance
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perspectives. This documentation assists in advocating the medical necessity and essential needs
related to the chosen interventions and aids in ongoing care planning.
Wound Cultures
Wound culture is a typical element that is vital in managing chronic wounds. Symptoms
of ordering wound culture constitute signs of infections that include increased redness, swelling,
warmth, purulent secretion, and slow dressing breakdown. Such cultures aid in ascertaining the
density and pathogenic organisms causing the infection, an essential aspect of strategizing the
treatment (Krasner & van Rijswijk, 2018). Routine wound culture and sensitivity samples are
usually collected from the wound area by rubbing a sterile throat swab over the wound or by
fashioning a roll of sterile gauze and then rinsing the wound with normal saline to remove
surface bacteria. This collected sample is then taken to the laboratory for a microbiological test.
Result Analysis
Lab analysis involves determining which bacteria are present and their susceptibility to
antibiotics. This information is essential to employ the correct antibiotic therapy (Krasner & van
Rijswijk, 2018). It should be noted that biopsy culture significantly impacts the choice of
antibiotics used in the treatment of a wound infection. A patient might be treated based on
clinical suspicion empirical therapy, but definitive therapy should follow based on the culture
findings. This makes the targeted antibiotics option more effective than the general ones since all
the medicines are designed to help control the identified pathogens and not others, increasing the
chance of success in infection control and wound healing. Besides, it helps reduce irrational
antibiotic utilization and consequently incorporates the utilization of broad-agent susceptibility to
antimicrobial resistance.
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Bone Biopsy and Tissue Biopsy
Biopsy encompasses two critical tests in chronic wound care, primarily when diagnosing
osteomyelitis, which threatens wound treatment (Krasner & van Rijswijk, 2018). A bone biopsy
usually takes a small portion of bone to assess osteomyelitis when clinical parameters and
examination, radiographic features, and localized bacterial infection are used. The procedure
usually involves employing local anesthesia and entering the bone using a biopsy needle to
collect the specimen (Féron et al., 2021). The collected bone tissues are prepared for lab testing
to show whether or not the site is infected, inflamed, or otherwise undergoing pathological
changes. This is a crucial part of diagnosing osteomyelitis and highlighting the management plan
for the particular patient.
On the other hand, there is tissue biopsy, whereby the practitioner removes a portion of
the wound tissue for histopathological purposes. This also helps establish other pathological
processes that have impacts on wound healing, such as malignancies, granulomatous diseases,
and other chronic inflammatory diseases. The procedure also involves histopathology, whereby a
sample of the affected tissue is pulverized and scrutinized under a microscope lens to check for
any irregularity in the structure of its cells.
Inflammatory Markers: CRP and ESR
Another critical biomarker that is applied when assessing chronic wound inflammation
with the erythrocyte sedimentation rate is the use of C-reactive protein. These biomarkers help
identify inflammation, infection occurrence, and severity within the human body. CRP and ESR
measures are high; this suggests inflammation and wound infection or other causes of
inflammation may be present (Krasner & van Rijswijk, 2018). These markers help the clinician
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evaluate the degree of infection and the body’s ability to respond to the treatment to manage
chronic wounds properly.
Consequently, boosted CRP and elevated ESR values require understanding with regard
to clinical background. Ongoing acute inflammation raises levels of CRP, while ESR rises more
during chronic inflammation. These indicators assist clinicians in distinguishing between an
acute process and a chronic condition of a particular disease process or organ system. An
important aspect is that even after treatment, these markers remain increased; this can indicate
that the infection continues or the treatment is ineffective, warranting a change in the therapy
approach.
Nutritional Labs: CBC and CMP
Screening of the nutritional status will involve blood count tests and comprehensive
metabolic panel tests for wound care. According to Krasner and van Rijswijk (2018), a lack of
essential nutrients has a negative impact on the wound care process. As such, it is helpful to
promptly diagnose if a patient has a nutrient deficiency or not. CBC gives information on
complete blood count, such as the level of hemoglobin white blood cell count. Persons with
abnormal values in these tests may suggest poor nutritional status or a compromised immune
system. CMP assesses electrolyte concentrations, liver and kidney statuses, and proteins that
course through the body and are paramount in wound healing.
Cassius et al., 2021, state that a deficit of vitamins, minerals, and proteins, which are
usual in patients, can affect wound healing dramatically. For instance, lack of zinc, vitamin C,
and protein also hinders the healing process of wounds and expands the period during which one
can be infected easily. Identifying these deficiencies through CBC and CMP enables the clinician
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to prescribe appropriate nutritional management for the wound and ultimately optimize
hospitalization for the duration of the hospitalization and promote the patient’s overall health.
Antibiotics
Starting antibiotics according to the cultured material is one of the proactive mechanisms
of wound treatment. Culture data present a more detailed picture of microorganisms identified on
the wound, thus encouraging the appropriate use of antibiotics based on the identified pathogen.
This increases the effectiveness of the treatment while decreasing antibiotic-resistant strains
because only the necessary antibiotics are used. Recommendations regarding antibiotic
administration establish duration, dosing, and specific choice of the antibiotic based on the
culture and sensitivity data to provide the best outcomes for the patient.
Vascular Studies: Arterial and Venous Doppler, ABI, TBI
Vascular assessment, especially in diabetic patients, is critical in determining care plans
because inadequate blood circulation slows down the healing process of the wound. US Doppler
tests, including arterial and venous imaging and ABI and TBI, are essential in assessing the
vascular situation. These help establish the status and magnitude of peripheral artery disease
(PAD) and venous insufficiency, underlining causes of chronic wounds (Cassius et al., 2021).
The interpretation with Doppler studies and ABI/TBI chiefly includes measuring the flow rates
and pressure levels. Particularly low or high values may be reflective of severe vascular
involvement, which may, therefore, warrant treatments like vascularisation or compression
therapy.
Vascular investigations also have essential functions in deciding operation procedures as
well. In the instances where the patient has not responded to the non-surgical treatments,
invasive methods like angioplasty or bypass operation may be used. The core idea is that the
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decisions concerning the patients’ treatments are made with the help of accurate vascular
assessment, which improves the results of wound care procedures and the patient’s health.
Psych Consult for Non-Compliance
Psychological interventions require incorporation into the treatment process of patients’
wounds because such people cannot follow prescribed regimens. Conditions like depression,
anxiety, and a lack of motivation are all examples of psychological barriers that could affect a
patient’s willingness to follow through with wound care protocols. A psych consult may
recognize such problems, including coming up with solutions to these issues to increase total
compliance and productivity.
Treatment approaches that can be used to encourage patients to adhere to the
recommended procedures include psychological encouragement, encouragement to seek
counselling, and behavioral modification. Self-management programs and interventions can also
be classified as these approaches since they try to improve the patient’s motivation, knowledge,
and involvement regarding their care plan.
OT and PT for Offloading Wounds
OT, PT, and other empiric interventions such as splinting, ROM, and pressure-relief
techniques are essential for addressing contractures and managing pressure in chronic wounds. It
reduces pressure on wounds as these therapies facilitate healing and help prevent the worst of its
form from developing. These are specific to occupational therapists who deal with appliances
and methods to aid a patient in carrying out tasks within the abilities summoned without putting
much pressure on the affected part. On the other hand, physical therapists use actions and stances
to build the patient’s strength and freedom, which play a role in offloading. Offloading strategies
involve off-bearing shoes, pressure-reducing leggings, and orthotics.
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Multidisciplinary Team Approach
Wound management, therefore, requires a holistic, interprofessional team for clients,
where most team members contribute with their specialist skills and knowledge, addressing all
the main facets of the client’s needs. This team usually comprises physiologists, doctors, nurses,
wound care specialists, dieticians, and psychologists/counsellors who contribute to the patient’s
healing in their respective capacities. The role of the physicians is to oversee the client’s medical
and treatment needs, while nurses and specialized wound care nurses attend to the wound care
needs of the client daily (Krasner & van Rijswijk, 2018). This keeps the nutritionist involved in
ensuring the patients are well-fed as the psychologist attends to psychosocial factors. Healthcare
teamwork contributes to patient-centred medical solutions and improved care delivery processes
for the best results.
Medical Necessity Charting
The provider needs to document the reasons as to why each test or treatment was
necessary since the need for some of these services may be doubtful. This comprises an
analytical assessment of the patient, the rationale for the need to perform ordered labs and
studies, and the documentation of patients’ responses to the treatment. Charting has specific vital
points that should be followed, including accuracy, magnification of abbreviations, and ensuring
that all the necessary information is recorded. Clinical decision-making is enhanced through it
and serves as a communication tool between the different healthcare providers, allowing
essential legal and insurance measures to be met.
Conclusion
This is a presentation of an efficient and effective process of ordering the lab and studies
in wound management and meaningful use according to the standard of care. Healthcare
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providers can achieve better outcomes by implementing an MDT approach, focusing on the
required charting actions, and involving OT and PT in inpatient treatment. Enhancing the
concept of Wound care in 2020, the focus on interactions with various practitioners and
specialties underlines the necessity of integration and a cohesive approach toward wound
management.
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References
Cassius, C., Seta, V., Monfort, J.-B., Baudot, N. A., Rivière, S., Mekinian, A., Frances, C.,
Barbaud, A., & Senet, P. (2021). Systemic sclerosis is associated with lower limb
vascular stiffness and microvascular impairment: results from a prospective study.
Clinical Rheumatology. https://doi.org/10.1007/s10067-021-05672-0
Eriksson, E., Liu, P. Y., Schultz, G. S., Martins?Green, M. M., Tanaka, R., Weir, D., Gould, L.
J., Armstrong, D. G., Gibbons, G. W., Wolcott, R., Olutoye, O. O., Kirsner, R. S., &
Gurtner, G. C. (2022). Chronic wounds: Treatment consensus. Wound Repair and
Regeneration, 30(2). https://doi.org/10.1111/wrr.12994
Féron, F., de Ponfilly, G. P., Potier, L., Gauthier, D.-C., Salle, L., Laloi-Michelin, M., Munier,
A.-L., Jacquier, H., Vidal-Trécan, T., Julla, J.-B., Carlier, A., Abouleka, Y., Venteclef,
N., Grall, N., Mercier, F., Riveline, J.-P., Senneville, É., Gautier, J.-F., Roussel, R., &
Kevorkian, J.-P. (2021). Reliability and Safety of Bedside Blind Bone Biopsy Performed
by a Diabetologist for the Diagnosis and Treatment of Diabetic Foot Osteomyelitis.
Diabetes Care, 44(11), 24802486. https://doi.org/10.2337/dc20-3170
Krasner, D. L. K., & Rijswijk, L. van . (2018). Chronic Wound Care: The Essentials E-Book. In
fliphtml5.com. Jeremy Bowden.
Fireside Chat:
labs, studies and the standard of
care when the results return
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Objectives
By the completion of this module the participant will be able to:
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Summary
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